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Spring/Summer 2003
This case report is from Dr. Bryan Springer's passed accreditation challenges with the American Academy of Cosmetic Dentistry. It is an example of restoring a single front tooth to blend in with the existing smile. The report that follows is only part of the extensive documentation that was done and is not in its entirety. This case reflects the exceptional quality of our dentistry at the Aesthetic Smile Studio.
Introduction. Achieving natural aesthetics by harmoniously matching the shape and color of a single anterior crown is probably one of the greatest challenges in restorative dentistry. Considerable improvements in porcelain fused to metal and all-ceramic crowns have made it possible to create durable and aesthetically optimal restorations that are no longer discernible from the natural dentition. However, it is the artistic flare of the laboratory technician that ultimately controls the success of the final restoration.
Most clinicians do not have the luxury of an in-house laboratory, so it becomes imperative to effectively communicate the correct anatomy, translucency, opacity, and polychromatic variations of teeth to increase our success. Strategies to accomplish this include: photographs, color slides, customized shade tabs, and detailed lab prescriptions with color mapping. All of which can recreate the natural beauty with the tooth in question while saving the virgin enamel of the others.
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History. The patient is a 37 year-old male in excellent physical health, and has no contraindications to routine dental care. He is married and is the father of two. He currently works for the local sheriff's department in their drug enforcement unit. During one of his latest hygiene appointments, it was noted that a previous amalgam restoration was failing. He was educated on the benefits of treatment and the value of an aesthetically bonded restoration. This stimulated questions regarding his anterior crown. He stated that he had always been displeased with the color of this crown, specifically the black line. He wondered if the bonded material could cover this defect. I attempted to explain the functional and aesthetic applications of different materials and how they interact with one another. I advised a more acceptable result would be gained with total replacement of the existing crown with a non-metal restoration which would allow for a more natural appearance.
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Conclusion. This case demonstrates that the newer all-ceramic systems can effectively match the natural dentition when combined with the artistic expertise of the laboratory technician. Effective wax-ups, photographs, slides, and detailed color mapping are just several aids for better communication. With these adjuncts, the traditional difficulty of matching a single tooth to the existing dentition is lessened. Another benefit is the conservative nature of the procedure compared to a comprehensive smile enhancement. For patients that desire a minimalist approach, the pressed ceramic restoration in key in creating an aesthetic and natural-looking result.
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